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OBGYN > Ovarian Tumors > Flashcards

Ovarian Tumors Flashcards

1
Q

Concerning characteristics of a pelvic mass

A

Worry about pelvic mass if >8cm, solid or cystic+solid, nodular, multilocular, + doppler flow, bilateral

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2
Q

3 categories of ovarian tumors

A

Epithelial, germ cell, or stroma.

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3
Q

Metastatic ovarian tumors

A

Usually GI tract (Krukenberg), breast, endometrium

Usually spreads via direct exfoliation; can be lymphatic too, more rarely hematogenous

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4
Q

Epithelial tumors (65-70%)

A

20+ years (esp older)

Serous cystadenocarcinoma, mucinous, endometriod, clear cell, Brenner, undifferentiated

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5
Q

Germ cell tumors (15-20%)

A

0-25+ years

Teratoma, dysgerminoma, endodermalsinus tumor, choriocarcinoma,embryonal carcinoma

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6
Q

Sex cord stromal (5-10%)

A

All ages

Granulosa-theca cell tumors, Sertoli-Leydig cell tumors, fibromas

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7
Q

What is the most common ovarian tumor?

A

Epithelial is #1 most common

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8
Q

Etiology of epithelial ovarian tumor

A

Thought to be 2/2 chronic uninterrupted ovulation → malignant transformation

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9
Q

Risk factors for epithelial ovarian tumor

A

Early menarche, infertility, late menopause, nulliparity, delayed childbearing, increasing age
10-15% have familial syndrome (e.g. BRCA 1>2 or HNPCC)

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10
Q

Protective factors for epithelial ovarian tumor

A

OCPs are protrective (50% if on OCP x 5yrs), also tubal ligation / hysterectomy

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11
Q

Symptoms of epithelial ovarian tumor

A

Asx or vague, nonspecific complaints (lower abd pain, bloating, distention, early satiety, other GI sx, urinary frequency / dysuria / pelvic pressure when more advanced, ascites if later)

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12
Q

Physical exam findings of epithelial ovarian tumor

A

Fixed, solid, irregular pelvic mass +/- ascites.

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13
Q

Epithelial ovarian tumor met to umbilicus

A

Sister Mary Joseph nodule

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14
Q

Diagnosis of epithelial ovarian tumor

A

Pelvic U/S; CT/MRI can be helpful too, then look for mets / other primaries (barium enema, IVP, etc)
Get a CA-125.
If wondering about other types of tumors, alpha-fetoprotein, LDH, hCG too.

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15
Q

Staging of epithelial ovarian tumor

A

Surgical (TAHBSO, omentectomy, peritoneal washings, Pap smear of diaphragm, sampling of pelvic / periarotic lymph nodes).
Many present in stage III/IV (2/2 vague symptoms) and 5-yr survival low.
Goal is optimal debulking (no tumor > 1cm left behind)

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16
Q

Treatment of epithelial ovarian tumor

A

Usually do adjuvant carboplatin + paclitaxel
If optimal debulking achieved, can do intraperitoneal chemo if tolerated
CA-125 elevated in 80% epithelial tumors - not for screening, but to track tx /recurrence
Can also get CT scans to follow serially

17
Q

Most common type of epithelial ovarian tumor

A

Most common type: serous cystadenocarcinoma, but types can vary from borderline to high malignancy

18
Q

Germ Cell ovarian tumor

A

Most grow rapidly, limited to one ovary, stage I at time of diagnosis, curable!
95% benign

19
Q

Symptoms of germ cell ovarian tumor

A

Capsule distention → pain, hemorrhage, necrosis → acute pelvic pain; can also torse / rupture

20
Q

Dysgerminoma

A 
No differentiation (totipotent)
Most common malignant germ cell tumor
Uniquely radiosensitive! but still do chemo (better fertility)
LDH= tumor marker
21
Q

Embryonalcarcinoma

A

Starting to differentiate towards:
Endodermal sinus tumor
Choriocarcinoma
Teratoma

22
Q

Endodermal sinus tumor

A

Differentiation: Extraembryonic (yolk sac)

AFP = tumor marker

23
Q

Choriocarcinoma

A

Differentiation: Trophoblastic (placental)

hCG = tumor marker

24
Q

Teratoma

A

Differentiation: Embryonic (fetal)
Benign cystic mature teratoma = dermoid cyst = most common germ cell tumor!
Cystic, has skin / hair / teeth /etc
Do a cystectomy for definitive dx & to r/o malignancy!
Immature teratoma = malignant version

25
Q

Treatment for benign germ cell ovarian tumors

A

For benign tumors (mature teratomas) → cystectomy or oophorectomy

26
Q

Treatment for malignant germ cell ovarian tumors

A

For malignant tumors, unilateral salpingo-oophorectomy if fertility desired, or TAH/BSO
Everything except stage IA dysgerminomas / immature teratomas gets multiagent chemo
Usually BEP = bleomycin, etoposide, cisplatin=Platinol
Can follow response with tumor markers
Dysgerminomas are uniquely radiosensitive - but often still do combo chemo to protect fertility

27
Q

Sex cord-stromal tumors

A

Generally low grade, don’t recur, usually unilateral
Treatment with unilateral sapingooophorectomy
No role for chemo or radiation in these tumors

28
Q

Granulosa-Theca cell tumors

A

Are #1 (70%)
Can happen at any age
Functional: can make lots of estrogens → endometrial hyperplasia, cancer 2/2 stimulation!
See Call-Exner bodies (pathognomonic) - with grooved “coffee-bean nuclei”

29
Q

Symptoms of Granulosa-Theca cell tumors

A

Can cause precocious puberty, feminization, menstrual irreg, secondary amenorrhea, postnemopausal bleeding 2/2 high estrogen

30
Q

Diagnosis of Granulosa-Theca cell tumors

A

High estradiol, inhibin A/B

31
Q

Sertoli-Leydig cell tumors

A

Are more rare
Mostly in women < 40
Like the ovary grew a little pair of testicles: making androgens
Sx: see virilizing effects (breast atrophy, hirsutism, deepend voice, etc) + oligo / amenorrhea.

32
Q

Ovarian fibroma

A

Derived from mature fibroblasts, not functional

Can be a/w ascites: tumor + ascites + right hydrothorax = Meigs syndrome

33
Q

Fallopian tube cancers

A

Really rare, usually adenocarcinoma,
Behave like ovarian cancer (peritoneal spread, ascites)
More frequently in caucasians, BRCA ½, nullips, infertility

34
Q

Symptoms of fallopian tube cancers

A

Usually asymptomatic
Classic = “Latzko’s triad”, profuse watery discharge + pelvic pain + pelvic mass but only in 15%
Hydrops tubae profluens (intermittent hydrosalpinx) = spontaneous or pressure-induced watery / blood tinged vaginal discharge that makes abdominal mass shrink

35
Q

Work up of fallopian tube cancer

A

Pelvic U/S, CA-125 can be up, cervical cytology rarely shows malignancy
Usually dx @ surgery (since so rare); stage surgically

36
Q

Treatment of fallopian tube cancer

A

Treat like epithelial ovarian carcinoma (TAHBSO, omentectomy, cytoreduction, peritoneal sampling, LN sampling, etc) and then carboplatin + paclitaxil

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